Evaluation of the Clinical Effects of Abobotolinum Toxin A (Dysport) Injection in the Treatment of Neurogenic Lower Urinary Tract Dysfunction Dysport injection in bladder and urethra
Vol. 19 No. 01 (2022),
Purpose: Neurogenic lower urinary tract dysfunction (NLUTD) is one of the most challenging problems in urology. In recent years, Onabotulinum toxin A (Botox) is considered a second-line treatment in these patients. This study aimed to evaluate the clinical effects of Abobotolinum toxin A (Dysport) into the bladder and urethra.
Materials and Methods: We classified our patients with NLUTD into three groups: neurogenic detrusor overactivity (group 1), detrusor sphincter dyssynergia (group 2), and patients with both symptoms (group 3). The severity of the patient’s symptoms was assessed using the Urinary Distress Inventory- Short form (UDI-6), urodynamic study, and post-void residual urine (PVR) at baseline. After injection of Dysport, the patients were evaluated by the change in UDI-6 score, PVR, and the patient’s general satisfaction. In group 1, 500-900 U diluted Dysport injected intra-vesical. If associated with detrusor sphincter dyssynergia (group 3), 100 U diluted Dysport injected peri-urethral. In group 2, only 100 U diluted Dysport injected peri-urethral.
Results: Data from 52 women with NLUTD were analyzed. The mean age was 51.3 ± 21.6 years. The prevalence of detrusor overactivity and the value of Q max was more in group 1. However, the amount of PVR was more in groups 2 and 3. The overall success rate was acceptable in all three groups. In addition, there were significant improvements in UDI-6 parameters.
Conclusion: Peri-urethral injection of Abobotolinum toxin A is effective and safe. However, the selection of the patients and the dose of toxin needs more studies.
- Abobotolinum toxin A, Neurogenic, Urethra, Voiding dysfunction
How to Cite
Przydacz M, Denys P, Corcos J. What do we know about neurogenic bladder prevalence and management in developing countries and emerging regions of the world? Ann Phys Rehabil Med 2017; 60: 341-6.
Liao L. Evaluation and Management of Neurogenic Bladder: What Is New in China? Int J Mol Sci 2015; 16: 18580-600.
Seth JH, Dowson C, Khan MS, et al. Botulinum toxin-A for the treatment of overactive bladder: UK contributions. J Clin Urol 2013; 6: 77-83.
Schurch B, Hauri D, Rodic B, Curt A, Meyer M, Rossier AB. Botulinum-A toxin as a treatment of detrusor-sphincter dyssynergia: a prospective study in 24 spinal cord injury patients. J Urol 1996; 155: 1023-9.
Dykstra DD, Sidi AA, Scott AB, Pagel JM, Goldish GD. Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol 1988; 139: 919-22.
Steinhardt GF, Naseer S, Cruz OA. Botulinum toxin: novel treatment for dramatic urethral dilatation associated with dysfunctional voiding. J Urol 1997; 158: 190-1.
Jiang YH, Wang CC, Kuo HC. OnabotulinumtoxinA Urethral Sphincter Injection as Treatment for Non-neurogenic Voiding Dysfunction - A Randomized, Double-Blind, Placebo-Controlled Study. Sci Rep 2016; 6: 38905.
Soler JM, Previnaire JG, Hadiji N. Predictors of outcome for urethral injection of botulinum toxin to treat detrusor sphincter dyssynergia in men with spinal cord injury. Spinal Cord 2016; 54: 452-6.
Hervé F, Viaene A, Everaert K. Onabotulinumtoxin A injections in detrusor facilitate self-catheterisation in a patient with paraplegia and bladder outlet dyssynergia. BMJ case Rep 2017.
Uebersax JS, Wyman JF, Shumaker SA, McClish DK. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Neurourol Urodyn 1995; 14: 131-9.
Kuo HC. Therapeutic outcome and quality of life between urethral and detrusor botulinum toxin treatment for patients with spinal cord lesions and detrusor sphincter dyssynergia. Int J Clin Pract 2013; 67: 1044-9.
Schurch B, Yasuda K, Rossier AB. Detrusor bladder neck dyssynergia revisited. J Urol 1994; 152: 2066-70.
Chancellor MB, Fowler CJ, Apostolidis A, et al. Drug Insight: biological effects of botulinum toxin A in the lower urinary tract. Nat Clin Pract Urol 2008; 5: 319-28.
de Groat WC, Fraser MO, Yoshiyama M., et al. Neural control of the urethra. Scand J Urol Nephrol 2001; 35: 35-43.
Kakizaki H, Fraser M, De Groat W. Reflex pathways controlling urethral striated and smooth muscle function in the male rat. Am J Physiol Regul Integr Comp Physiol 1997; 272: R1647-R56.
Shafik A. Study of the effect of vesical filling and voiding on ureterovesical junctions and internal urethral meatus: the filling and meato‐vesico‐ureteral reflexes. Int J Urol 1998; 5: 449-53.
Blaivas J. Pathophysiology of lower urinary tract dysfunction. Urol Clin North Am 1985; 12: 215-24.
Elbadawi A, Schenk EA. A new theory of the innervation of bladder musculature. Part 4. Innervation of the vesicourethral junction and external urethral sphincter. J Urol 1974; 111: 613-5.
Caremel R, Courtois F, Charvier K, Ruffion A, Journel NM. Side effects of intradetrusor botulinum toxin injections on ejaculation and fertility in men with spinal cord injury: preliminary findings. BJU Int 2012; 109: 1698-702.
Siegel S, Noblett K, Mangel J, et al. Results of a prospective, randomized, multicenter study evaluating sacral neuromodulation with InterStim therapy compared to standard medical therapy at 6‐months in subjects with mild symptoms of overactive bladder. Neurourol Urodyn 2015; 34: 224-30.
Kuo H-C. Recovery of detrusor function after urethral botulinum A toxin injection in patients with idiopathic low detrusor contractility and voiding dysfunction. Urology 2007; 69: 57-61.
Kuo HC. Satisfaction with urethral injection of botulinum toxin A for detrusor sphincter dyssynergia in patients with spinal cord lesion. Neurourol Urodyn 2008; 27: 793-96.
Liao Y-M, Kuo H-C. Causes of failed urethral botulinum toxin A treatment for emptying failure. Urology 2007; 70: 763-6.
Franco I, Landau-Dyer L, Isom-Batz G, Collett T, Reda EF. The use of botulinum toxin A injection for the management of external sphincter dyssynergia in neurologically normal children. J Urol 2007; 178: 1775-80.
Emami M, Shadpour P, Kashi AH, Choopani M, Zeighami M. Abobotulinum - a toxin injection in patients with refractory idiopathic detrusor overactivity: injections in detrusor, trigone and bladder neck or prostatic urethra, versus detrusor - only injections. Int Braz J Urol 2017; 43: 1122-8.
Liao YM, Kuo HC. Causes of failed urethral botulinum toxin A treatment for emptying failure. Urology 2007; 70: 763-6.
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